Lower Limb Proprioceptive Exerciseshealth.nzdf.mil.nz/assets/Uploads/Lower-limb... · • Check that the entire lower limb kinetic chain contributes to the movement • Check maintenance

NEW ZEALAND DEFENCE FORCESLOWER LIMB INJURYPREVENTION PROJECT

Lower LimbProprioceptive

Exercises

Phil Handcock

School of Physical Education

Dunedin

NEW ZEALAND

© 2008 School of Physical Education, University of Otago, Dunedin, NZ

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PARTICIPANT SCREENING

As part of preparatory screening for dynamic proprioceptive training, consideration needs

to be given to the following;

• age

• gender

• weight

• fitness level and recent training history

• injury history, particularly overuse injuries of the lower limb

• shoes

• landing surface

• fatigue level (timing of training relative to other physical exertions and duties)

• preparatory activity (warm up and dynamic range of motion)

• progression

• movement quality

TRAINING STRATEGIES AND INITIAL INSTRUCTIONS

• Encourage participants to use the whole lower limb kinetic chain during landing, ie

use hips, knees and ankles to absorb landing forces.

• Have participants turn their body and position themselves appropriately for the task

• Move the feet if need be to avoid rotational landing forces at the knee and ankle -

step out

• Expect the unexpected - land as if on an unstable surface

• Dare to fall - don’t be afraid of losing balance but have a plan for loss of balance so

as to avoid injury - i.e. always under control

EXERCISE MONITORING AND EVALUATION

As quality of movement should be emphasised for all exercises, it helps to clearly specific

the objective of each exercise and the key points to consider during the movement. Check

for

• range of motion in the target joints and ensure that each joint is contributing

• symmetry of movement - make contra lateral comparisons where possible

• even weight distribution and transfer of weight

• prolonged foot contact between jumps - emphasis should be on brief but controlled

foot contacts

• excessive wobbling or shaking which may indicate fatigue or weakness in some of

the supportive muscles

• posture - should be upright with good alignment in the frontal plane

• arm and leg coordination

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• changes in the amplitude of movement

• sequencing of head and trunk movement

• use of all joints in the lower limb (kinetic chain) to contribute to force absorption and

minimize ground reaction forces

• knee position - the centre of the patella should track over the 1 and 2 toe to avoidst nd

stressors on the medial and lateral elements of the knee joint

• foot position and contact with the surfaces - check alignment and full sole contact

with the surface

• reliance on escape postures/movements or steps that signal a loss of balance. This

may be acceptable for the more advanced exercises but should not occur with the

basic and low demand exercises

PROGRESSIONS

• static exercises to dynamic tasks

• increased demand for balance

• increased demand for strength - usually through increased horizontal or vertical

amplitude of movement

• increased demand for movement control + coordination

• increased demand (loading + amplitude)

• increased reactivity demands - ie tasks with less opportunity to preplan movements

• decreasing attention investment - most tasks can be completed with ease when the

participant concentrates on the movement. Some would argue that the real test of

how routine a movement is can be assessed by whether they can perform the task

when forced to concentrate on something else. Mental distraction tasks can be used

to take the focus off the movement.

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NZDF Exercise Group 1

Floor exercises

Exercise Objective:

Range of motion training, strength and balance

Exercise instruction

• Walk along a line

Observation points

• Check foot part contact

• Check maintenance of balance

• Check range of motion

Progressions

A. Walk along a line

B. Walk on toes

C. Walk on heels

D. Walk on inside of foot

E. Walk on outside of foot

F. Walk ‘toed in’

G. Walk‘toed out’

H. Eyes closed

A B C D E

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In place tasks

Exercise Objective:

Dynamic balance


• Standing on single leg

• Perform a slow controlled 1/4 squat and return to standing

Observation points

• Check full foot contact

• Check that the entire lower limb kinetic chain contributes to the movement


• Check body alignment

Progressions

A. Perform a slow controlled 1/4 squat and return to standing

B. Perform a slow controlled ½ squat and return to standing

C. Eyes closed

D. Reach and pick up a weight from the floor

E. Balance on toes

F. Balance on heels

G. Non-stance leg extended behind, out to the side or flexed forward

Start 1/4 ½ Reach and Pick

© 2008 P. Handcock, School of Physical Education, University of Otago, Dunedin, NZ

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NZDF Exercise Group 2 continued

Toes Heels

Non-stance leg to the side Front Rear


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Rocker board exercises

Exercise Objective:



• Place feet in parallel stance across the board

• Move board through full range of motion

Observation points



• Check full range of motion

Progressions

A. Plantar/dorsiflexion controlled range of motion

B. Eversion/Inversion controlled range of motion

C. Change feet position to 45E angle or 135E angle - controlled range of motion

D. Single foot - all 4 foot positions - controlled range of motion

E. Balance - all 4 foot positions - double then single foot

F. Balance - all 4 foot positions - eyes closed - double then single foot

G. Step on

H. Lunge on, lunge off

I. Hop on


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Wobble board exercises

Exercise Objective:



• Place feet in parallel stance across the board

• Move board through full range of motion

Observation points



• Check full range of motion

Progressions

A. Two foot - run the circumference

B. Two foot - balance

C. Single foot - balance

D. Eyes closed -run circumference - balance

E. Single leg 1/4 and ½ squat

F. Step on

G. Lunge on, lunge off

H. Catch and pass

I. Hop on and balance

B C E


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F G


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Sway Limits

Exercise Objective:

Explore limits of sway in double limb and single limb stances - balance recovery


• Stand with feet one foot width apart

• Sway as far forward, backward, and to each side as possible without losing balance

or having to step out

Observation points

• Ensure full foot contact at all times

• Use an external marker e.g. a pole to monitor limits

Progressions

A. Double foot sway limits

B. Single foot sway limits

C. Reach forward for an object at waist/chest level

D. Reach forward from a tandem stance

E. Reach forward from a single limb stance

F. Reach to the side

G. Reach across body

H. Complete from a 1/4 and ½ squat position

DCB


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F

G

E


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Single Leg Dynamic Exercises

Exercise Objective:

Complete exercise under control


• Assume a single leg stance

• Complete a controlled squat to 90Eof knee flexion

• Return to stance position

Observation points

• Ensure mid point of patella passes over the middle toe of the forward foot

• Emphasise slow controlled movement

• Check for lateral stability

Progressions

A. Rise on toes first to initiate upward movement

B. Repeat with closed eyes

C. Add hand held weights

D. Hop and land in same position under balance

E. Flying crunch - elbow to opposite knee

F. 5 way lunge - lunge forwards, at 45E, 90E, 135Eand backwards - for 135E twist body

around at the hips and step diagonally and to the rear so that upper body is facing to the

left (or right) -rear.

Start A D


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E

F - turned out to rearF - sideF - forward


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Single Leg Squat Lunge

Exercise Objective:

Complete a controlled squat lunge


• Assume a tandem stance (2 foot lengths from toe of rear foot to heel of forward foot.

• Complete a controlled squat to 90Eof knee flexion (forward leg)

• Return to lunge position

Observation points


• Emphasis slow controlled movement


Progressions

A. Elevate rear foot on low stool or chair (shifts weight forward)

B. Rise on toes to initiate upward movement

C. Add hand held weights

D. Close eyes

E. Continuous alternate leg lunges in place

F. Progressive walking lunge with trunk twist


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Partner Single Leg Squat

Exercise Objective:

Complete a controlled single leg squat with a partner


• Assume a single right leg stance facing a partner

• Lean forward and flex left hip forward grasping partners left ankle

• Hop to adjust position so that both participants have a single leg stance and are

supporting their partner’s left leg

• Perform a 1/4 squat

• Return to stance position

Observation points


• Emphasis slow controlled movement


Progressions

A. Perform a ½ squat

B. Coordinate with partner to hop forward, backwards and to the side

C. Close eyes

D. Coordinate with partner to circle clockwise or counterclockwise


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NZDF Exercise 9

Star Excursion

Exercise Objective:

Touch various locations with non support foot without losing balance or stepping out


• Stand steadily in single L leg support

• Squat 1/4

• Reach forward with R foot as far as possible NW, N, NE, E, SE, S, SW

Observation points

• Check for good body alignment


• Gauge distances reached

Progressions

• Eyes closed


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Line Hops

Exercise Objective:

Hop continuously over the line for the specified repetitions


• Complete low amplitude hops over the line

• L foot landing on L side of the line and R foot landing on R side

Observation points


• Ensure full foot contact and that hip and knee contribute to force acceptance and force

production

• Check that participant clears the line with each repetition

Progressions

A. Increase landing distance from line i.e. increase lateral movement

B. Single leg hops - L to L, R to R

C. R foot landing on L side of the line and L foot landing on R side

D. Progress forwards along the line

E. Progress backwards

F. Increase lateral jumping distance

B B - incr distance C


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D or E


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Hop and hold

Exercise Objective:

Dynamic balance and landing


• Standing on single leg

• Hop forward as far as possible and ‘stick’ the landing

Observation points





Progressions

A. Eyes closed

B. 2 hops and ‘stick’ the landing

C. sideways and backwards hops

D. hop in square pattern in each direction


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Tethered movements

Exercise Objective:

Complete an arced side stepping movement while resisting the bungy cord pull


• Tether the bungy cord securely to a fixture.

• Secure the other end of the bungy cord to the participant’s waist

• Move to stretch the bungy cord until the participant is just able to maintain single leg

balance

• Side-step slowly in an arc, maintaining tension in the bungy cord

Observation points


• Emphasis slow controlled movement so that the participant emphasises single leg

stance

• Check that participant does not move closer to the tethering fixture

Progressions

A. Cross-over steps

B. Single leg hops

C. Add obstacles to hop over

D. Hop further away from the bungy tether and ‘stick’ landing

E. Turn to have left, right, and back facing the bungy tether - repeat various exercises

F. Close eyes for exercises

G. Perform exercises while catching and throwing a ball


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Beam exercises

Exercise Objective:

Complete exercises on the beam without losing balance or stepping out


• Tandem walk along the beam

Observation points


• Check ranges of movement

Progressions

A. Eyes closed

B. Tandem walk on toes

C. Tandem walk on heels

D. Sideways shuffle along the beam

E. Cross over sideways walk along the beam

F. Sideways calf raise

G. Tandem walk pivots

H. Tandem walk dips (1/4 and ½ squats)

I. Tandem walk - hop and stick landing

J. Use rounded side of the beam


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Alternate beam exercises

Exercise Objective:

Dynamic balance, weight transfers


• Standing side on on the beam on toes

• Step back to drop and land

Observation points


• Check that the entire lower limb kinetic chain contributes to force absorption


Progressions

A. Standing side on on the beam on toes - step back to drop and land

B. Eyes closed

C. Jump up to land on beam then over to land on the other side

D. Continuous jumping laterally over with one foot always on the beam

E. Hop on and balance


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River Rocks

Exercise Objective:

Dynamic balance and landing


• Move across the imbedded rocks

Observation points




Progressions

A. Walk forwards, backwards and sideways

B. Eyes closed

C. Jump continuously from rock to rock


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Inversion/Eversion Board

Exercise Objective:

Move under control along and across the boards


• Walk along with feet either side of the eversion board (gutter)

• Walk along with feet either side of the inversion board (roof)

• Walk across boards

Observation points

• Check for full foot contact


• Check that the knee and hip movement also contribute to movement

Progressions

A. Eyes closed

B. Hop 2 foot along roof, along gutter

C. Hop 2 foot - roof, gutter, roof

D. Hop 1 foot along board

E. Hop 2 foot - roof, 180Espin, roof, gutter,180Espin, gutter

F. Hop 1 foot across board

G. Hop 1 foot - roof, 180Espin, roof, gutter,180Espin, gutter


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Spin jump

Exercise Objective:

Complete a low amplitude two footed jump, turning through 90E


• Initiate a low amplitude two footed jump

• Turn your body through a 90E counterclockwise turn

• Land safely on two feet

Observation points

• Aim for minimal jump amplitude

• Aim to complete all of the turn (rotation) in the air

• Land without any transferred body rotation

• ‘Stick’ the landing - that is no stepping or weight transfer to maintain balance

Progressions

A. Spin jump CCW, land, pause, spin jump CW back to starting position

B. Continuous movement with no pause between jumps

C. Continue CCW in 90E increments through a full 360E rotation

D. 180E, 270E and 360E spins

E. Single foot spin jumps

Documents

Lower Limb Proprioceptive Exerciseshealth.nzdf.mil.nz/assets/Uploads/Lower-limb... · • Check that the entire lower limb kinetic chain contributes to the movement • Check maintenance